Dispensing Guidance from Brighton and Sussex University Hospitals on Oral Anti Cancer Medicines
A reminder from Brighton and Sussex University Hospitals NHS Trust regarding oral anticancer medication.
On 22nd January 2008 the National Patient Safety Agency (NPSA) issued a Rapid Response Report alerting all healthcare staff of potentially fatal outcomes if incorrect doses of oral anticancer therapy are prescribed, dispensed or administered. The overriding principle of this document is that oral anti-cancer medicines are managed to at least the same standards as IV chemotherapy. The greatest area of risk with oral anticancer medicines appears to be prescribing on out-patient or FP10 forms as there is no standard written information given with them for Pharmacists to be able to check the prescription thoroughly.
In response to this alert, our policy at Brighton and Sussex University Hospitals NHS Trust is that all oral chemotherapy, including hydroxycarbamide, will be prescribed in-house by the specialist team looking after the patient. All dispensing of oral anti-cancer medicines will take place in the Hospital Pharmacy Department where Pharmacists have received training in the handling of oral chemotherapy. GPs will be informed by letter of any chemotherapy regime that their patients have been prescribed. Under no circumstances should this treatment be prescribed by the GP.
In our local area there has previously been a fatal incident involving oral chemotherapy prescribed incorrectly and several near misses under similar circumstances. These occurred when patients were started on blister packs. Please take extra care to ensure oral anticancer medicines are not added unintentionally to these prescriptions.
The term ‘oral anticancer medicines’ refers to all drugs with direct anti-tumour activity, orally administered to cancer patients including traditional cyctotoxic drugs, such as busulfan, capecitabine, cyclophosphamide and hydroxycarbamide, as well as newer agents such as imatinib, sunitinib and thalidomide. It does not include hormonal treatments such as tamoxifen or anastrazole nor does it include cytotoxic medicines prescribed for other conditions (e.g. methotrexate for rheumatoid arthritis).